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Background: The mortality rate for cerebrovascular diseases is much higher in Japan than in North American and West European countries. The primary aim of this study was to elucidate from an epidemiological perspective, the associations between cerebral infarction and demographic factors, medical history and other clinical measurements including pulse wave velocity, a newly introduced non-invasive measurement procedure used to assess aortic stiffness. Methods: This was a hospital-based, matched case–control study in northern Japan where there is a high incidence of cerebrovascular disease. The study group consisted of 92 matched pairs of cerebral infarction patients (cases) and healthy individuals admitted for a thorough health check-up (controls) at the Southern Tohoku General Hospital in Fukushima Prefecture, Japan. A conditional logistic regression model was used in the statistical analysis. Results: In univariate analyses, 14 variables were significantly associated with cerebral infarction, of which four remained significant in the final multivariate model. These were family history of hypertension (odds ratio (OR) = 8.61), cerebrovascular diseases (OR = 13.70), high-density lipoprotein cholesterol of 40 mg/dL or higher (OR = 0.08), and pulse wave velocity over 1600 cm/s (OR = 2.92). Conclusion: Findings from the study indicate that a high pulse wave velocity, in addition to other traditional risk factors, may be associated with a higher risk of cerebral infarction. Further prospective studies are necessary to evaluate the use of this measure as a predictor of the disease. [ABSTRACT FROM AUTHOR]

Antibody tests are used as surveillance tools for informing health policy making. However, results may vary by type of antibody assay and timing of sample collection following infection. Long-term longitudinal cohort studies on antibody assay seropositivity have remained limited, especially among Asian populations. Using blood samples obtained at health physicals (2020-2022) of healthcare workers (mass vaccinated with mRNA COVID-19 vaccines) at a Japanese medical center, we measured N-specific antibodies using two commercially available systems. Roche Elecsys Anti-SARS-CoV-2 measures total antibodies and Abbott Alinity SARS-CoV-2 IgG measures only IgG. Among 2538 participants, seroprevalence was found to be 16.6% via total antibody assay versus 12.9% by IgG-only (including grayzone) by mid-June 2022. For 219 cases with a previous PCR-confirmed infection, positivity was 97.3% using total antibody assay versus 76.3% using IgG-only assay at the 2022 health physical. Using PCR positive test date as day 0, while the positivity of the total antibody assay was retained for the entire study period (until more than 24-months post-infection), the IgG-only assay's positivity declined after month 4. The Mantel-Haenszel test found a significant difference in the two assays' seropositivity, between stratified groups of "within 3 months" and "4 months or more" from infection (P < 0.001). Our study found significant differences in seropositivity over time of total antibody versus IgG-only assays, suggesting an optimal assay for retaining sensitivity over the entire infection period when designing seroprevalence studies., (© 2024. The Author(s).)

Zinc deficiency, affecting more than 2 billion people globally, poses a significant public health burden due to its numerous unfavorable effects, such as impaired immune function, taste and smell disorders, pneumonia, growth retardation, visual impairment, and skin disorders. Despite its critical role, extensive large-scale studies investigating the correlation between patient characteristics and zinc deficiency still need to be completed. We conducted a retrospective, cross-sectional observational study using a nationwide Japanese claims database from January 2019 to December 2021. The study population included 13,100 patients with available serum zinc concentration data, excluding individuals under 20 and those assessed for zinc concentrations after being prescribed zinc-containing medication. Significant associations with zinc deficiency were noted among older adults, males, and inpatients. Multivariate analysis, adjusting for age and sex, indicated significant associations with comorbidities, including pneumonitis due to solids and liquids with an adjusted Odds Ratio (aOR) of 2.959; decubitus ulcer and pressure area (aOR 2.403), sarcopenia (aOR 2.217), COVID-19 (aOR 1.889), and chronic kidney disease (aOR 1.835). Significant association with medications, including spironolactone (aOR 2.523), systemic antibacterials (aOR 2.419), furosemide (aOR 2.138), antianemic preparations (aOR 2.027), and thyroid hormones (aOR 1.864) were also found. These results may aid clinicians in identifying patients at risk of zinc deficiency, potentially improving care outcomes., (© 2024. The Author(s).)

Objective: This study aimed to determine the rate of achieving the target blood pressure (BP) defined by Japanese hypertension management guidelines and to examine factors associated with achieving the target BP., Methods: This cross-sectional study, which was conducted between January 2012 and December 2015, examined the BP control status and associated factors among 9,016 Japanese community residents with hypertension. Residents were divided into the following six groups: G1, young, middle-aged, and early-phase elderly patients; G2, patients with cerebrovascular disease; G3, patients with coronary artery disease; G4, patients with chronic kidney disease with proteinuria; G5, patients with diabetes; and G6, patients with chronic kidney disease without proteinuria. BP target achievement rates were calculated for each group. A multivariate analysis identified factors associated with "therapeutic failure" of target BP., Results: The target BP was achieved by 52.6% participants in G1, 84.3% in G2, 50.6% in G3, 45.6% in G4, 48.7% in G5, and 75.0% in G6. The body mass index and receiving antilipidemic medication were associated with therapeutic failure., Conclusion: This study shows that achievement rates for treatment goals among Japanese patients with hypertension are still low. Body mass index and treatment of dyslipidemia may be associated with the control of BP.

Pneumococcal vaccination has been shown to reduce occurrence of invasive pneumococcal diseases in elderly patients. In this study, we investigated the real-world efficacy of pneumococcal vaccination implemented in elderly individuals in Japan. We reviewed the in-patient database of Juntendo University Hospital and selected elderly patients (≥65 years-old) who had received in-patient care in the general medicine department during 2014-2018. A total of 1355 patients were retrospectively enrolled and comprised of 1045 unvaccinated and 315 vaccinated elderly individuals. Prior vaccination was found associated with all-cause shorter hospital stays (adjusted RR = 0.66, 95% CI = 0.57 to 0.76) and less medical expenditure (adjusted RR = 0.76, 95% CI = 0.66 to 0.87) compared with no vaccination, as well as protection for all-cause in-hospital mortality (adjusted OR = 0.42, 95% CI = 0.22 to 0.83). The association of shorter hospital stays and less medical expenditure with vaccination was also observed in the context of pneumonia, although no altered risk in mortality was observed. In conclusion, this study is one of the first reporting real-world data after the initiation of pneumococcal vaccination program in 2014 in Japan. The national PPV23 vaccination program contributed to the reduction of all-cause in-patient days, mortality, and medical expenses in the elderly aged ≥65 years. Further data is warranted to evaluate the contribution from influenza vaccination and protein-conjugate based pneumococcal vaccine., Competing Interests: Declaration of Competing Interest T.N. has received honoraria for lectures from MSD K.K. A.W. has received honoraria for lectures from MSD K.K and Pfizer K.K. The authors declare that they have no known competing financial interests., (Copyright © 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Pneumonia is the third most common cause of death in Japan. Low vaccination rates are thought to be related to low levels of public subsidy. Since 2014, the Japanese government has offered subsidies through a 5-year national routine vaccination program of the 23-valent pneumococcal polysaccharide vaccine (PPV23) for older adults at age ≥65 years with 5-year age intervals. We previously reported that, 2 years into the 5-year program, the estimated vaccination rate was 40.6% at the end of 2015, a significant increase compared with periods before the program introduced. Here, we present an update on the estimated vaccination coverage of the 5-year national routine vaccination program at the end of 2018. The PPV23 vaccination rates were calculated by dividing the cumulative amount shipped to each municipality by the population aged ≥65 years. At the end of 2018, the completion of the 5-year national immunization program, the estimated cumulative vaccination rate was 74%. Stepwise regression analysis revealed that the annual PPV23 vaccination rate significantly increased after 2014 (from 2 to 5% prior to 2014, to 10-11% after 2014), and remained steady for 2014-2018. Our findings suggest that the 5-year national routine vaccination subsidy program was successful in achieving a steady and higher vaccination rate of PPV23 in Japan., Competing Interests: Declaration of Competing Interest T.N. has received a grant from Pfizer Inc. and honoraria for lectures from MSD K.K. A.W. have received honoraria for lectures from MSD K.K., (Copyright © 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

The 2011 Great East Japan Earthquake was the largest and most catastrophic earthquake and tsunami in Japanese history. The aim of the present study was to evaluate the burden and psychological characteristics of children at 2 years after this catastrophe to allow a better understanding of the situation and the provision of appropriate support. We investigated a cross-sectional study carried out in 2013 by sending a questionnaire to schools located in Miyagi Prefecture to be answered by parents or guardians. The questionnaire included the Strengths and Difficulties Questionnaire (SDQ) to estimate the psychological adaptation of children. Telephone consultations were provided for children with SDQ scores > 16 whose parents or guardians had given consent. From the target population of 12,742, a total of 4,074 responses were received (response rate: 32%), among which, 720 had an SDQ score > 16 and received a telephone consultation. At the time of the telephone consultation, 301 (42%) of the 720 children and parents or guardians showed some type of psychological reaction and were thus classified as "Insufficient recovery". Among these, 230 had not received social support at any point in time, suggesting the need for long-term psychological support. Those who resided in a coastal area tended to show a higher rate of psychological reactions than those in an inland area (27.1% vs. 12.9%, respectively). In conclusion, catastrophic disasters have a long-lasting psychological impact on children, and thus, long-term psychological support may be needed.

Objective: This study aimed to examine the associations between obesity and percentage vital capacity (%VC), as well as lifestyle-related disorders, among Japanese participants of a voluntary health checkup., Methods: Subjects were 7,892 individuals who participated in a medical health checkup from January to December 2007. Multivariate logistic regression analysis was performed to assess associations between low %VC (<80) and body mass index (BMI) and waist circumference (WC), as well as lifestyle-related disorders., Results: Medical histories of hypertension and dyslipidemia were more frequent in the low %VC group than in the normal %VC group in both sexes. In men, BMI was significantly associated with low %VC (25.0 ≤ C2 < 27.5, odds ratio (OR) = 2.10; 27.5 ≤ C3 < 30.0, OR = 2.23; C4 ≥ 30.0, OR = 3.46) relative to the first category (C1 < 25.0). A significant association was also observed between WC and low %VC (85 ≤ C2 < 90, OR = 1.40; 90 ≤ C3 < 95, OR = 1.55; 95 ≤ C4, OR = 2.51; relative to C1 < 85.0 cm). In women, BMI was significantly associated with low %VC in C3 and C4 (C3, OR = 2.05; C4, OR = 2.84), and WC was significantly associated with low %VC in C4 (C4, OR = 2.32)., Conclusion: Our results suggest that obesity may be associated with restrictive pulmonary function and underscore the importance of maintaining ideal body weight for the prevention of restrictive pulmonary dysfunction.

Objective: The aim of this study was to investigate the associations between the incidence of diabetes and the accumulation of markers of impaired glucose metabolism; i.e., pre-diabetes., Methods: This retrospective cohort study recruited 1,631 men without diabetes at baseline who attended more than two routine health check-ups at our institution between 2006 and 2012. The participants were divided into four groups based on the number of markers of impaired glucose metabolism exhibited at the initial examination. The following markers of impaired glucose metabolism were defined as risk factors for diabetes: a fasting plasma glucose level of ≥110 mg/dL, 2-hour plasma glucose level of ≥140 mg/dL and glycated hemoglobin (HbA1c) value of ≥6.0% (42 mmol/moL). The risk of developing diabetes was assessed using a multivariate analysis., Results: The median examination interval was 1,092 days. The incidence of diabetes rose in association with the number of markers. The subjects with two markers displayed a multivariate-adjusted odds ratio (OR) for diabetes of 19.43 [95% confidence interval (CI): 9.70-38.97] and the subjects with three markers displayed an OR of 48.30 (95% CI: 20.39-115.85) compared with the subjects with one or no markers., Conclusion: The present results demonstrate the impact of accumulating markers of impaired glucose metabolism on the risk of developing diabetes. Anti-diabetes intervention strategies should aim to comprehensively assess an individual's risk of developing diabetes at the pre-diabetes stage.

Objective: This study aimed to examine the association between lifestyle-related disorders and visceral fat mass, and to estimate an appropriate cutoff value for visceral fat mass that correlated with body mass index (BMI) and waist circumference (WC)., Methods: This cross-sectional study was conducted between July 2012 and August 2013 at Bange Kosei General Hospital, in Fukushima, Japan. All study participants were adult males who had completed voluntary medical check-ups that included estimation of visceral fat mass by bioelectrical impedance analysis (BIA). Participants were without past histories of atherosclerotic complications or were not currently taking medications for lifestyle-related disorders. Multivariate analysis was performed to estimate the association between lifestyle-related disorders and quartiles of visceral fat mass., Results: Of 536 total respondents, 442 were included in the analysis. Mean participant age was 56 years, and mean values of BMI, WC, and visceral fat mass were 24.1 kg/m(2), 85.9 cm, and 2.1 kg, respectively. Visceral fat mass ≥1.8 kg was positively associated with an increased prevalence of dyslipidemia, elevated blood pressure, and impaired glucose tolerance. Cutoff values that correlated with visceral fat mass (≥1.8 kg) were 85.3 cm for WC and 23.25 kg/m(2) for BMI., Conclusion: Visceral fat mass ≥1.8 kg was positively associated with lifestyle-related disorders and closely related to WC and BMI cutoff values used to diagnose obesity. BIA may be a useful method for assessing visceral fat mass, and these findings provide important evidence for the use of BIA in the early detection of central obesity for preventing lifestyle-related disorders.

Objective: The aim of this study was to establish a causal relationship between excess body weight and the onset of diabetes in a retrospective cohort study., Methods: This 10-year observational cohort study investigated 969 men and 585 women (23 to 80 years of age), who underwent voluntary complete medical check-ups and an annual 75-g oral glucose tolerance test (75 g-OGTT). Participants with fasting plasma glucose ≥126 mg/dL, 2-h glucose level in a 75 g-OGTT ≥200 mg/dL and/or received medical treatment for type 2 diabetes during the previous year were considered as new-onset diabetics. We assessed the independent contribution of increased BMI to the risk of developing type 2 diabetes with Cox proportional hazard model., Result: During the follow-up period, we diagnosed 86 men and 49 women with new-onset type 2 diabetes. In the Cox proportional hazards model, the risk of diabetes mellitus increased with increasing BMI, even after adjusting for age, sex, blood pressure, metabolic profiles, and insulin resistance. In the final model, setting BMI less than 25 as a reference group, the Hazard ratios for diabetes mellitus was 3.12 for those with a BMI of 25-27.4 and it was increased to 3.80 for participants with a BMI of 27.5 or higher., Conclusion: Overweight/obesity (high BMI) is an independent and dose-dependent risk factor for type 2 diabetes in overweight Japanese patients. Our results confirmed the usefulness of BMI as a classic parameter, and the importance of lifestyle modification and better management among people with overweight/obesity for prevention of type 2 diabetes mellitus.

Objective: To determine success rates in achieving goal blood pressures by measuring several factors including lifestyle characteristics associated with therapeutic failures for target treatment goals., Methods and Patients: This prospective observational cohort study (September 2008 to September 2010) collected information on blood pressure control status and healthy lifestyle practices listed in Belloc and Breslow's seven health practices through medical records and patients' self-administrated questionnaires among 1,264 of 1,753 Japanese hypertensive patients initially registered. Multivariate analysis was performed to estimate the association between lifestyle practices and "therapeutic failures" at the baseline survey., Results: Median age and proportion of males were 74 years and 41.1%. Therapeutic failures were 68.3% in non-elderly patients (<65 years of age) without diabetes mellitus or chronic kidney disease, 62.6% in patients with these diseases or those who had myocardial infarction, 41.8% in elderly patients (≥65 years of age) without these diseases and only 28.6% in patients with cerebrovascular disease. The total number of healthy lifestyle items was inversely associated with therapeutic failures in multivariate analysis among both sexes., Conclusion: The study revealed low achievement rates toward treatment goals, especially non-elderly patients without diabetes mellitus or chronic kidney disease, and patients with these diseases or those who had myocardial infarction. Our data indicated the necessity to improve physicians' awareness of the management of hypertension according to treatment guidelines and the importance of a healthy lifestyle to maintain goal blood pressure levels.

Aim: To examine and compare the predictive value of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C and LDL-C/HDL-C ratios for future cardiovascular outcomes in the general Japanese population., Methods: A total of 24,566 eligible participants aged 18 years or older, without cardiovascular disease, were enrolled through multiphase health screening and divided into quartile groups based on lipoprotein levels or ratios. Primary endpoints of the study were definitive acute myocardial infarction (AMI) and ischemic stroke, and cases of sudden death with unknown causes were not included. We used Cox proportional hazard models to examine the relationships between the quartiles and incidences of AMI or ischemic stroke, adjusting for traditional risk factors., Results: Mean age was 63.7 years for males and 60.7 years for females. Mean follow-up period was 2.7 years, and 40 cases of AMI and 182 cases of ischemic stroke were recorded. The hazard ratio (HR) for AMI was significantly higher in the top quartile of the LDL-C/HDL-C ratio and LDL-C levels, and third quartile of TC among male participants. The HR of male participants with a LDL-C/HDL-C ratio of 2.6 or higher was significantly higher than other quartiles. No association between lipoprotein levels or their ratio quartiles and ischemic stroke was seen for either sex after adjusting for risk factors., Conclusions: Our results indicated that the LDL-C/HDL-C ratio is an independent predictor for AMI, and the importance of better management of cardiovascular risks among people with high LDLC/HDLC ratios for the prevention of future cardiovascular disease.

Background: The relationship between achieving target blood pressures and medication modification among hypertensive patients in Japan is relatively unknown. We examined the incidence of prescription changes and how the prescription changes influence success rates in achieving target blood pressures in a group of patients with uncontrolled hypertension., Methods: This prospective observational cohort study (July 2006 to May 2007) examined the association between blood pressure control and antihypertensive medication among 2,735 Japanese hypertensive patients who completed four seasonal follow-ups and whose medications were verified. The primary outcome was "therapeutic failure" at the third follow-up survey. Logistic regression analyzed how prescription changes may influence therapeutic failure risk. Common medication changes were estimated using follow-up data., Results: Median ages and proportion of males were 73 years and 43.8% vs. 69 years and 45.6% in those with controlled and those with uncontrolled hypertension at baseline, respectively. At baseline, 1,496 patients were uncontrolled, and 296 (18.0%) changed prescriptions during the follow-up period. Among patients with diabetes mellitus, renal disease, or organ damage and vascular complications, who were uncontrolled at baseline, prescription changes during the year significantly increased therapeutic failures at the third follow-up after adjusting for related variables. About half of the changes at each follow-up visit remained in the same class or combination category., Conclusions: This study identified infrequent changes in prescription and minor modifications of medication even among uncontrolled hypertension. We highlight the importance of reviewing prescription content to maintain or improve blood pressure levels to achieve recommended treatment goals.

The number of children with undesirable lifestyles has recently increased. We tested the hypothesis that maternal feelings about pregnancy might be associated with their attitude towards promoting healthy lifestyles in their children. We used a city database collected from guardians of 204 randomly selected children aged 1 to 3 years in Nihonmatsu City, Fukushima. Maternal feeling about pregnancy was measured using a 10-point scale, and a child lifestyle score was calculated as the sum of desirable lifestyle habits (sleeping, eating, watching TV/videos, and tooth brushing). Associations between maternal feeling and her child's lifestyles were examined with multiple logistic regression analysis. For all lifestyle items, proportion of children with undesirable lifestyle habits was higher in the "unhappy group" (those who scored 1 to 9) than in the "happy group" (those who scored 10). In particular, a child's short sleeping hours (odds ratio [OR]=3.01) and lifestyle score of less than 3 ([OR] =3.60) were significantly associated with unhappy feelings. This was apparent among mothers aged 29 (median age) or younger. Our results indicate an association between a mother's unhappy feelings about pregnancy and her child's undesirable lifestyle, especially among relatively younger mothers. These findings provide public health implications important for early familial intervention to improve children's lifestyles.

In this observational cohort study, the authors assessed the achievement of treatment goals as defined in the Japanese Society of Hypertension's Guidelines for the Management of Hypertension (JSH 2004) among 2743 Japanese hypertensive patients who were followed for 1 year (follow-up rate of 82.6%). Median age was 72 years, and 45% were men. Achievement of treatment goals across all 4 seasons was very low, at 4.1% among patients with diabetes mellitus or renal disease, 3.9% among nonelderly patients (<65 years of age) without these diseases, and 30.8% among elderly patients (>or=65 years of age) without these diseases. These findings highlight the importance of maintaining appropriate blood pressure control. In addition, an analysis of factors associated with achievement rates identified the importance of weight control, lifestyle modification, and family history, and indicated a need for better blood pressure management before complications arise.

Objective: The purpose of this study was to evaluate the association between homebound status and newly certified need of care among elderly in a rural community and to clarify the characteristics of those in homebound status., Methods: The Iwate-KENpoku COhort (Iwate-KENCO) study (26,469 participants) spanned the period from 2002 to 2004 and was conducted in northern Iwate Prefecture, Japan. In the present study, 12,056 elderly (men, 4,751; women, 7,305) participated after being screened for eligibility (> or =65 years of age; without certification for need of care; and without a history of stroke, cardiac heart failure, or ischemic heart disease). Being homebound was operationally defined as walking outdoors for less than 5 minutes per day. Cox's proportional hazard model was used to estimate the hazard risk (HR) for newly certified need of care and the 95% confidence interval (95% CI) after controlling for confounding factors by gender., Results: After a mean follow-up period of 2.65 years, 200 men (4.2%) and 412 women (5.6%) obtained certification for need of care. Homebound status was significantly associated with newly certified need of care in women (HR=1.64, 95%CI=1.29-2.09), but not in men (HR=1.07, 95%CI=0.76-1.52). Homebound status among elderly women was associated with nutritional status, missing teeth, and irregular daily rhythms., Conclusion: These findings suggest that being homebound is a risk factor for elderly women receiving certification for need of care.

This observational study assessed the achievement of treatment goals, as defined by the Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2004). These goals are: <140/80 mm Hg in elderly patients (65 years and older), <130/80 mm Hg in patients with diabetes or kidney disease, and <130/85 mm Hg in younger patients (younger than 65). From July 2006 to May 2007, 72 physician members of the Fukushima Hypertension Conference enrolled a total of 3320 patients from Fukushima Prefecture, Japan. The median age of the patients was 71 years and 46% were male. The success rate was 27% among patients with diabetes mellitus or renal disease, 30% among those younger than 65 years, and 66% among the elderly without the diseases. Factors significantly associated with an increased risk of failure to achieve goals were obesity, dyslipidemia, family histories of diabetes mellitus or hypertension, and number of antihypertensive drugs used. The presence of atherosclerotic complications decreased the risk. This study revealed low achievement rates, identified the importance of weight control and family histories, and indicated a need for better management to prevent complications.

Aim: We examined changes in ability- and performance-based instrumental activities of daily living (IADL) among community-dwelling elderly a year after a baseline survey was taken., Methods: Community-dwelling elderly in Otama village were interviewed in 2006 and followed for one year. Based on ability- and performance-based IADL assessments regarding 3 daily tasks from the Kihon Checklist (using public transportation, shopping for daily necessities, and managing bank accounts), each was assigned to one of three performance groups: good, borderline, or low., Results: One year after the survey, the proportion of those assigned to the good performance group decreased, while those assigned to either the borderline or low performance groups increased. Among those assigned to the good performance group, 75.6% remained in that group, 21.1% shifted to the borderline performance group, and 3.3% shifted to the low performance group one year later. Compared to those remaining in the good performance group, those who shifted to the borderline performance group had significantly lower muscular strength, less healthy attitudes, and lower IADL as measured by the Tokyo metropolitan Institute of Gerontology (TMIG) Index of Competence., Conclusions: Fewer elderly were assigned to the good performance group and more were assigned to the borderline and low performance groups one year after the survey. Shifts from the good to borderline performance group were common among those with lower physical status and less healthy attitudes. We conclude that ability- and performance-based evaluations are important tools to screen those in the borderline performance group requiring preventive care.

Despite the significant adverse health consequences of diabetes, data on lifestyle characteristics and mortality among the Japanese with diabetes are limited. Our objective was to investigate the lifestyles of Japanese community residents with self-reported diabetes and their 3-year total mortality. Our cohort was 7178 randomly selected residents aged 30-79 years in Nihonmatsu City, Fukushima Prefecture, Japan; 5187 responded to the survey (72% response rate) and were followed for 3 years. Baseline data were collected using questionnaires in December 2002, and deaths were monitored monthly. Only 19% of women and 4% of men followed six to seven of Breslow's seven health practices. The percentage of people with self-reported diabetes was 4.2%[95% confidence interval (CI), 3.4-5.1%] for women and 7.9% (95% CI, 6.8-9.1%) for men, and the 3-year total mortality was 1.4% (95% CI, 1.0-1.9%) for women and 3.1% (95% CI, 2.4-3.8%) for men. Factors associated with 3-year mortality were fair or poor subjective health [odds ratio (OR) = 3.1, 95% CI 1.7-5.5] and self-reported diabetes (OR = 2.3, 95% CI 1.1-4.9) in a logistic regression controlling for age and gender. In stratified analyses, 3-year mortality of those with diabetes was significantly higher than those without the disease among men and those aged under 65. Those with diabetes were more likely to have self-reported comorbidities, high blood pressure and report poor subjective health regardless of age and gender, and healthier lifestyles among the women and those aged under 65. Our results support the need for community-based primary prevention measures to improve the lifestyles of residents, along with secondary prevention approaches to monitor those with diabetes for complications and to give them lifestyle instructions.